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Re: routine intrapartum labs ---> placenta pathology From: Charlie Chambers (cchamber@alumni.rice.edu) Sat May 27 22:10:26 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DoctorJoe@aol.com: "Stump the Professors (from placental pathology)" Previous message: Joe Cutchin: "Re: new case" In reply to: Geffrey Klein, MD: "Re: routine intrapartum labs ---> placenta pathology" Next in thread: John Robertson MD: "Re: routine intrapartum labs ---> placenta pathology" on 5/27/00 9:48 PM, Geffrey Klein, MD at gklein@icsi.net wrote: > At 5:58 PM -0500 on 5/27/00, Geffrey Klein, MD wrote: >>> >> >> But as Wooley would say, the default is not doing something unless >> there is some clinical benefit. So, as a patient, please convince >> me why I should pay the hospital for a cord gas. IOW, what I am >> getting for my money? > > Her is another one that is irritating.. I got billed for placental > pathology on my wife's last delivery. It was $450 dollars. We had > an uncomplicated term delivery. What could that have possibly added > to the management of my wife's pregnancy? > > Does anyone routinely send the placenta to pathology? Why? > >> there are some that advocate sending placenta for pathology for much the same reasons listed with re: to cord gases. The placenta can in "the right hands" tell much regarding antepartum events. However, those right hands are limited to few pathologist, e.g. Dr. Bernischke in CA. Most path groups will merely return with "normal placenta" and bill for the work. I went to school in Houston with Drs. Creasy and Parisi and did some research and published regarding cord gases. The argument goes that no vigorous child will become the issue in a malpractice case, therefore, the normal child with pH of 6.95 will never be an issue. However, a depressed child for whatever reason with a pH not suggestive of acidosis or hypoxia eliminates the argument, why didn't you perform the c/s earlier? In addition, it does provide to neonatalogy one etiology to eliminate from differential. The kicker is if depressed baby with bad pH, you've just signed the check. I've eased up on the everyone gets blood gases. But I do as ashley suggests which is to clamp and cut cord, and send if baby is not doing well. In my humble opinion, much more practical than sending the path on the placenta. As a departure, Dan was correct about Dr. Stehman getting the difficult case correctly at the stump the professors at ACOG. I felt he was perhaps the most learned and astute of the members of the panel. I was definitely impressed by his knowledge. -- ############################################################################ Charlie Chambers, MD "No matter where you go... 1732 McAndrews Road West there you are." Burnsville, MN 55337 (952)435-0531 Dr. Buckaroo Banzai cchamber@alumni.rice.edu ############################################################################ Next message: DoctorJoe@aol.com: "Stump the Professors (from placental pathology)" Previous message: Joe Cutchin: "Re: new case" In reply to: Geffrey Klein, MD: "Re: routine intrapartum labs ---> placenta pathology" Next in thread: John Robertson MD: "Re: routine intrapartum labs ---> placenta pathology"

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